Introduction: Central venous catheterizations(CVC) are frequently carried out by anesthesiologists. This procedure is mainly meant for obtaining central venous pressure, administer long-term fluids, blood, and inotropes, aspirate air emboli, and administer total parenteral nutrition. Aims: To compare the use of ultrasound guided technique versus surface anatomical landmark techniques in terms of success rate, number of times required for internaljugular vein cannulation, and complications. Materials and Methods: 90 adult patients age between 20-70years who were scheduled for major elective surgeries participated in this prospective randomized study. After inducing anesthesia, the CVC was placed by an experienced team using sterile technique and was randomly divided into 2 groups of 45 each. internal jugular vein (IJV) cannulation was performed on a group AG patient using the anatomical surface landmark technique and for patients of group UG, ultrasound-guided technique was used to cannulize the internal jugular vein. Results: The success rate for cannulation on first attempt was 66.7% in Group AG and 88.9% in Group UG. The mean duration of placement time in Group AG was 539.96 ± 64.24 seconds and in Group UG was 322.47 ± 11.05 seconds (p value <0.001). Carotid punctures were notedin ten patients in AG group and none in UG group (p value 0.001) which was statistically highly significant. Hematoma were developed in five patients of AG group. Conclusion:We concluded that the ultrasound guided technique offers faster access with higher first attempt success rate and fewer complications compared to anatomical landmark technique.