BACKGROUND: A recent survey showed that rib fractures constituted 9% of the 731,823 trauma cases, and that 13% of the patients with rib fractures developed 13,086 complications of which 48% were related to the chest wall trauma. Such complications as pneumonia, atelectasis, bronchiectasis, empyema thoracis, acute respiratory distress syndrome, prolonged intensive care unit and hospital stay, and the concomitant mortality can be prevented or reduced by good analgesic therapy which is the subject of this study. METHODOLOGY: Randomized prospective study of intercostal nerve block (ICNB) with 0.5% Bupivacaine group and the intravenous Tramadol (IVT) injection group. RESULTS: There were 64 adult patients who were studied with multiple rib fractures caused by blunt chest trauma. Out of these, there were 54 (84.4%) men and 10 (15.6%) women. According to mechanism of the blunt chest injury, motorcycle (popularly known as “okada”) and tricycle (popularly known as keke napap) accidents significantly accounted for the cause of multiple rib fractures in 50 (78.1%) of the patients. Before analgesia, the 64 patients rated their chest pain as either severe (68.7%) or moderate (31.3%) whereas at one hour after commencement of analgesic, only 6.3% and 42.2% still rated their chest pain as severe and moderate pain respectively, while 45.3% had mild pain and 6.3% had no pain. And at 24 hours all the 64 patients had either no pain (76.6%) or mild pain (23.4%) (p values <0,0001 and 0.002). Comparison of efficacy based on changes in pain scores among the two groups of intervention also showed that ICNB was more effective than IVT at both the one hour and 24 hours re-assessment periods. Improvement in respiratory function as evidenced by lung function tests also correlated positively with the control of chest pain in both treatment arms but better in the intercostals nerve block group. CONCLUSION/RECOMMENDATION: This study recommends the routine use of intercostal nerve block for chest pain control in blunt traumatic multiple rib fractures where the expertise and 0.5% bupivacaine injection are available and there are no contraindications in the patients.