Background and Aim: Central venous catheterization is commonly performed in elective and emergency major surgeries and in intensive care units. Cannulation of the IJV is usually preferred because of its anatomical position and large diameter in the trendelenburg position. The purpose of our study was to compare the two commonly practiced anterior and posterior approaches for cannulation of internal jugular vein. Material and Methods: This was a randomized observational study in which fifty adult patients of ASA physical status II and III undergoing elective major gastrointestinal, and cardiothoracic and vascular surgeries requiring central venous pressure monitoring or central venous access were included in the study. Patients were randomly assigned to two groups on a one is to one ratio randomly: Landmark Guided Anterior Approach (A Group) and Landmark Guided Posterior Approach (P Group). The analyzed criteria were number of attempts, time taken to identify the vein (Access time), total duration of cannulation, carotid puncture, hematoma, pneumothorax, hemothorax, catheter kinking, catheter displacement, thrombophlebitis, nerve injuries and overall total complications. Results: The number of attempts to identify the vein was lesser with the posterior approach than the anterior approach. The access time and duration of cannulation were lesser with the posterior approach. Cannulation by posterior approach reduced the rate of carotid puncture and haematoma. Conclusion: Landmark guided posterior approach is better than landmark guided anterior approach for internal jugular vein cannulation as it improves the success rate, reduces the access time and overall total duration of cannulation.