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Background and Aims Traumatic rib fractures are associated with significant morbidity and mortality, particularly in older patients. Fascial plane blocks have been used in the last decade to enhance analgesia, minimise the Opioid related side effects, reduce the respiratory complications and the associated critical care admissions. This study evaluates the impact of fascial plane nerve blocks compared to conservative management on mortality and hospital length of stay (LOS) in patients with rib fractures.Methods A retrospective cohort study was conducted on adult patients admitted with rib fractures to QEQM hospital between 2018 and 2023. Patients were divided into two groups: those who received a nerve block (serratus plane and erector spinae blocks, n=149 patients) and those who were managed conservatively (n=830 patients). Outcomes assessed included in-hospital mortality and LOS. Subgroup analysis by age was also performed. A p-value <0.05 was considered statistically significant.Results The fascial plane block group showed a lower overall in-hospital mortality compared to the conservative management group (7.4% vs 11.32%) and across all age groups except those over 80 years, where mortality was comparable (12.3% vs 12.17%). These differences were not statistically significant (p-values >0.05)( figure 1). The mean hospital LOS was significantly reduced in the nerve block group compared to conservative management group (11.127 days vs 14.620 days, p = 0.0305). The most notable reduction was in patients over 80 years (12.41 vs. 17.92 days, p = 0.0264) (figure 2).Abstract EP016 Figure 1Percent mortality in patients with fascial plane block vs conservative group patients in different age groupsAbstract EP016 Figure 2Average LOS in patients with fascial plane block vs conservative group patients in different age groupsConclusions Fascial plane blocks in patients with traumatic rib fractures are associated with a significant reduction in hospital LOS and a trend toward lower mortality. They also have the advantage of avoiding the side effects and the high-level monitoring associated with epidurals. These findings support the use of nerve blocks as part of multimodal pain management, especially in older populations. Larger prospective studies are needed to confirm the mortality benefit.