Objective To study the effects of dexmedetomidine combined with ropivacaine for intercostal nerve block on pain and sleep in patients with multiple ribs fracture. Methods One hundred and seventy-eight patients with multiple ribs fracture were divided into two groups according to the random digits table method: control group (ropivacaine, 88 cases) and experimental group (dexmedetomidine combined with ropivacaine, 90cases). On the second day after admission, the patient underwent intercostal nerve block guided by ultrasound. Pain score of resting pain, cough pain and night pain at each time point and the sleep condition was compared after 3 days. Results In 4—7 ribs fracture patients, the resting pain score in the experimental group was significantly lower than that in the control group within 16 hours: (1.3 ± 0.6)scores vs. (1.7 ± 0.7) scores, (2.1 ± 0.4) scores vs. (2.2 ± 0.6) scores, (2.2 ± 0.3) scores vs. (2.3 ± 0.3)scores; while in the cough pain score, the experimental group was significantly better than the control group within 24 hours: (1.6 ± 0.8) scores vs. (2.5 ± 0.9) scores, (3.0 ± 0.7) scores vs. (3.3 ± 0.8) scores, (3.3 ± 0.7) scores vs. (4.0 ± 0.9) scores, (4.9 ± 1.0) scores vs. (5.4 ± 1.0) scores. The differences were statistically significant (P<0.05). In patients with more than 7 ribs fractures, the resting pain scoreand cough pain score ,the experimental group were significantly better than those in the control group within 12 hours (P<0.05). On the first day and the second day after the block, the insomnia scores in the experimental group were significantly lower than those of the control group: (2.5 ± 0.7) scores vs. (4.2 ± 1.6) scores, (2.8 ± 0.8) scores vs. (4.5 ± 1.5) scores. The difference was statistically significant (χ2＝7.374, 7.989, P < 0.05) . Conclusions For patients with multiple ribs fracture, the use of dexmedetomidine combined with ropivacaine for intercostal nerve block can improve the analgesic effect, prolong the analgesic time, and improve sleep quality.