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Background and Aims Rib fractures are associated with significant mortality and morbidity secondary to pain induced hypoventilation which is often exacerbated by opioid use. In elderly patients, each rib fracture increases pneumonia risk by 27% and mortality by 19%. In light of recent Medicines and Healthcare products Regulatory Agency (MHRA) guidance against the use of modified-release opioids for post-operative pain due to the associated risk of opioid-related complications, the use of opioid-sparing techniques has become imperative. Regional anaesthesia offers a promising alternative but is underutilised. This study aims to assess rib fracture pain management at Wythenshawe Hospital and implement a structured pain management pathway promoting the early use of erector spinae plane (ESP) block catheters.Methods We retrospectively reviewed patients with radiologically confirmed rib fractures at Wythenshawe Hospital between 1st September 2024 and 17th March 2025. Data included patient demographics, STUMBL (STUdy of the Management of BLunt chest wall trauma) scores (calculated retrospectively), analgesic plans, 72-hour oral morphine equivalent (OME) consumption, and the use of regional techniques.Results 106 patients were identified with a median age of 69. No STUMBL scores were recorded, and retrospective scoring showed 39% were at high risk of complications. 21 patients required admission and none received regional analgesia. Nearly all patients were managed with opioids, with a median 72-hour OME of 44 mg.Abstract P160 Figure 1A summary of our rib fracture dataConclusions This study identified the underutilisation of regional anaesthesia and formal risk stratification in the management of rib fractures. Higher STUMBL scores are associated with an increased risk of complications with scores of 11–15 associated with 29% probability of complications, whilst scores exceeding 30 indicate an 88% risk. In response, we have implemented a trust-wide pathway, integrating early use (within 24 hours) of ESP block catheters for patients with a STUMBL score >10. A follow-up audit is underway to assess implementation uptake and its effect on opioid consumption.