Most patients can say where the block has got to. If it is above the umbilicus at five minutes, I position the patient slightly head up. The block comes on more rapidly than surgeons can scrub, prep, drape, and catheterise the patient. Most surgeons will test by pinching the site of incision with a clamp. Patients are not usually aware of this happening.
Hypotension is a frequent problem.
I sometimes give 10 mg ephedrine prophylactically, and sometimes add 10 mg to the IV bag. Others will give intramuscular ephedrine prophylactically, but this seems rather uncontrollable. At the first suggestion of nausea I give 10 mg ephedrine IV before even checking the blood pressure. Very few patients require any additional sedation. Exceptionally anxious patients may need IV benzodiazepines, but most can be emotionally supported and persuaded to put up with any discomfort, at least until the baby is born.