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Background and Aims Introduction Genitofemoral neuralgia is a severe, debilitating condition that significantly reduces patients’ quality of life. While oral analgesics are a viable treatment option for some, other cases prove refractory to standard management and require more invasive approaches. Ultrasound-guided genital branch of genitofemoral nerve blocks have shown success, providing adequate pain relief in up to 70% of cases.Methods Case description A 38-year-old male presented to the urology clinic with left-sided grade II varicocele and underwent spermatic vein ligation. During the procedure, the left inguinal peritoneum was accidentally lacerated and promptly sutured upon recognition of the laceration. One month later, he presented to the emergency urology clinic with persistent left testicular pain and marked tenderness, pain during intercourse and neuropathic pain ongoing since the procedure. Following an inconclusive microbiological, imaging, and laboratory workup, he was referred to the pain clinic almost two years after surgery. At the pain clinic, following a sterile skin preparation and draping, an ultrasound-guided genital branch of the genitofemoral nerve block was performed using 6 mg (1,5 mL) of dexamethasone, 4 mL of 0.5% levobupivacaine, and 2.5 mL of normal saline. A volume of 4 mL of anesthetic solution was deposited within the inguinal canal but outside the spermatic cord, with another 4 mL deposited inside the spermatic cord.Results The patient experienced complete pain relief for 3 days, with the intensity decreasing from VAS 10/10 to VAS 6/10 over the following three weeks. A repeat block using the same technique was administered one month later, again resulting in significant pain reduction.Conclusions Ultrasound-guided genitofemoral nerve block is a viable, safe and effective option for managing chronic or postoperative testicular pain.