Fifty-nine patients with unilateral multiple rib fractures were randomized to receive either ultrasound-guided serratus anterior plane block (SAPB) with continuous local anaesthetic infusion (n=30) or thoracic epidural analgesia (EA) (n=29). The primary outcome of interest was the reduction in the numerical rating scale (NRS) pain score at rest and upon movement from baseline to Day 2. Secondary outcomes included forced expiratory volume in 1 second (FEV1), FEV1%, total oxycodone consumption via patient-controlled analgesia, and patient satisfaction. Outcomes were assessed at 30 minutes, 1 hour, 2 hours, 12 hours, and on Days 1 and 2 after the block. Overall, the results revealed that both methods provided significant pain relief, but EA was associated with superior pain reduction during the first 12 hours. SAPB remains a valid alternative when EA is contraindicated, particularly in patients with rib fractures.