Purpose of Review <p>Rib fractures are common in emergency care and are associated with substantial morbidity driven by pain-related hypoventilation and pulmonary complications. Contemporary management is shifting toward early, opioid-sparing multimodal strategies and broader use of ultrasound-guided regional analgesia. This review summarizes recent evidence relevant to clinicians treating rib fracture pain in the emergency department.</p> Recent Findings <p>Recent reviews and practice guidance emphasize that multimodal regimens can reduce opioid exposure while maintaining analgesic effectiveness. Ultrasound-guided thoracic nerve blocks, including erector spinae plane, serratus anterior plane, and intercostal approaches, are increasingly described as feasible in the emergency department with favorable safety profiles when performed with appropriate technique. In older adults with multiple rib fractures, regional techniques have been associated with clinically meaningful improvements in patient-centered outcomes such as delirium risk in observational data. Important evidence gaps remain, however, and standardized care pathways are still evolving.</p> Summary <p>Rib fracture pain management is increasingly outcomes-driven and opioid-sparing. Early multimodal pharmacotherapy should be paired with consideration of ultrasound-guided regional analgesia for selected patients, particularly those at higher risk for opioid-related adverse effects or pulmonary decline. Protocolized, emergency department-based approaches may improve timeliness and consistency of care.</p>