Background: There are several methods to control pain, especially in traumatic patients with rib fractures. Intrapleural analgesia (IPA) and intercostal block methods are recommended in patients with rib fractures to control pain. Here, we aimed to evaluate and compare the effects of IPA and intercostal block on patients’ clinical conditions. Materials and Methods: This is a randomized clinical trial that was performed in 2020–2021 on thirty traumatic patients with rib fractures. We collected the results of arterial blood gas in all patients before interventions including HCO3, pH, pO2, and pCO2 and also evaluated pain of patients. The first group underwent intercostal blockade with standard method with bupivacaine, and for the second group of patients, a chest tube was implanted. Patients were monitored for up to 12 h for pain intensity and need for analgesics. Results: The mean levels of HCO3 decreased in both groups after the interventions, and this decrease was more significant in patients in the intercostal blockade group ( P < 0.05). The mean levels of pO2 increased in both groups after interventions, especially in patients in the intercostal blockade group ( P < 0.05). The mean pCO2 levels also decreased in both groups ( P < 0.05). The mean pain intensity in both groups decreased significantly after the intervention ( P < 0.05) and also the mean pain intensity in the intercostal blocking group decreased significantly more than the group treated with chest tube ( P < 0.05). Conclusion: Intercostal blockade through bupivacaine is more effective than chest tube administration of bupivacaine in patients with rib fractures.