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Blunt chest trauma with isolated or multiple rib fractures constitutes a common presentation in Emergency Department (ED), particularly in elderly people. Rib fractures in the elderly create short- and long-term disabilities with a dramatic impact. Pain management in the elderly could be problematic due to non-steroidal anti-inflammatory drugs (NSAIDs) contraindication or interaction with other drugs. We performed this retrospective study collecting and retrieving all patients aged 65 or older, with a diagnosis of rib(s) fracture(s) during an 18-month period. We analyzed the different treatments chosen, and divided them into subgroups: oxycodone- naloxone, and other treatments (also divided in: codeineacetaminophen; NSAID or Acetaminophen; Tramadol or Tapentadol). A total of 475 elderly patients (aged 65 and older) with single or multiple rib fractures were evaluated in our ED in 18 months: of these 410 patients were considered eligible, with a mean age of 79.28 years (standard deviation 7.83). 185 were male and 225 were female. Our study confirms the efficacy and tolerability of fixed association of oxycodone and naloxone. This association determined the highest and fastest reduction on Numeric Pain Scale reported by patients and is significantly better than other drugs in oral administration.