Non-Inferiority Study of Erector Spinae Plane Block Compared to Thoracic Epidural in Pain Management of Rib Fractures

Inclusion Criteria: * 18 years or older * Radiological evidence of 3 or more rib fractures * Within 48 hours of admission to hospital with rib fractures * Can actively participate by answering questions during TEA or ESPB placement * Moderate-severe (4-10 out of 10) pain at the time of enrollment Exclusion Criteria: * Greater than 48 hrs since admission to the hospital with rib fractures * Patient refusal * Prisoner * Infection at the site of TEA or ESPB insertion * Allergy to local anesthetics * Depth from skin to catheter placement target 6 or more centimeters * Greater than 7 consecutive ribs involved on each side * Other regional or epidural block already received * Unable to follow commands/altered mental status * Dementia * Sepsis (temperature \> 38 degrees Celsius \& positive blood cultures) * Elevated intracranial pressure (ICP \> 12 mm Hg) * Coagulopathy (INR \> 1.4) or recent therapeutic anticoagulant use (varies with which medication the patient is on) * Preexisting central nervous system disorders, such as multiple sclerosis * Thrombocytopenia (Platelets \<70,000) * Spine fracture or previous back surgery * Preload dependent states (aortic stenosis, hypertrophic obstructive cardiomyopathy) * Aortic transection * Hemodynamic instability (patients with MAPs \<60 and/or patients requiring pressor support) * Tattoo at sight of catheter placement