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Intranasal (IN) ketamine offers an alternative to intravenous procedural sedation in the Paediatric Emergency Department. A review of the literature was carried out to assess evidence for the efficacy of IN ketamine as an alternative to IV ketamine for use as procedural sedation. 150 individual papers were found, of which eight were included as studies providing data relevant to the clinical question. The author, date, country of publication, group studied, study type, outcomes, key results and study weaknesses were tabulated. The clinical bottom line is that in paediatric patients requiring sedation, IN ketamine has a slightly lower likelihood of success than intravenous ketamine; however, offers a useful needle-free alternative. With a clear explanation of the evidence to parents and shared decision-making, it should be considered in severely needle-phobic children.