Optimal Method of Pain Management in Patients With Multiple Rib Fractures

Inclusion criteria: 1. Age ≥ 18 years; 2. Three or more rib fractures; 3. Pain 1. Severe pain (i.e. causing deleterious affect on respiratory mechanics, respiratory rate, or oxygen saturations), OR 2. Mild to moderate pain (i.e. minimally affecting respiratory mechanics, respiratory rate, or oxygen saturations) that does not respond to oral or intravenous analgesics within 4 hours; 4. Patient has capacity to provide informed consent, as determined by: 1. Clinical assessment by study staff MD who will explain the study to potential subjects and then ask them to summarize the purpose, procedures, risks and alternatives back to the MD; 2. GCS 15; 3. Clinical assessment by independent MD who will explain the study to potential subjects and then ask them to summarize the purpose, procedures, risks and alternatives back to the MD. Exclusion criteria: 1. Lack capacity to provide informed consent; 2. Intubation at time of enrollment; 3. Contraindications to procedure (e.g. known allergy to local anesthetics). 4. Presence of infection at site of catheter placement; 5. Current use of anticoagulant medication; 6. Known allergy to silver; 7. Inability to obtain informed consent; 8. Body weight \> 300 lbs; 9. Pregnancy; 10. Significant co-morbid medical illness that might alter the metabolism of the anesthetic agents and result in unexpected toxicity (hepatic, renal or cardiopulmonary disease). All women of child-bearing age will receive a urine pregnancy test prior to the start of the interventional portion of the study. A positive test result excludes the patient from inclusion in the study.