Objective To analyze the perioperative use of tramadol in patients undergoing meniscus surgery, so as to provide reference for subsequent rational drug use. Methods The data of 126 patients who underwent arthroscopic meniscus surgery in our hospital from Dec. 2018 to Oct. 2019 were analyzed retrospectively. According to whether tramadol was taken within 1 month before surgery, the patients were divided into tramadol group (n=33) and non-tramadol group (n=93). The general data, the use of tramadol during perioperative period and the occurrence of adverse drug reactions during follow-up were statistically analyzed. Results There were no significant differences in age, gender, body mass index, first clinical diagnosis, anesthesia methods, operation time, operation methods or perioperative non-steroidal anti-inflammatory drug (NSAID) usage between the 2 groups (all P>0.05). Compared with the non-tramadol group, patients in the tramadol group had a risk of continuing drug use 3 and 6 months after surgery (odds ratio[OR]=3.294, 95% confidence interval[CI]1.383-7.846; OR=2.795, 95% CI 1.037-7.534). One month after the operation, among the 29 patients who received meniscus operation alone, the continuous use rate of tramadol was 100.0% (8/8) in the tramadol group and 76.2% (16/21) in the non-tramadol group, with no significant difference (P=0.129); the use rate of tramadol was 90.5% (67/74) in 74 patients receiving less than 3 knee surgery procedures, and 100.0% (52/52) in 52 patients receiving no less than 3 knee surgery procedures, with significant difference (P=0.022). The prescription dose of tramadol in the tramadol group within 1 month after surgery was higher than that in the non-tramadol group (P=0.004), but there was no significant difference in the prescription dose of tramadol between the 2 groups within 3 or 6 months after surgery (both P>0.05). The overall incidence of adverse drug reactions in patients was 11.9% (15/126) during follow-up period, and the incidence of gastrointestinal distress was higher in the tramadol group than that in the non-tramadol group (21.2%[7/33] vs 2.2%[2/93]), with significant difference (P=0.001). The incidence rates of gastrointestinal distress, peptic ulcer, allergy or other adverse drug reactions in patients taking tramadol and NSAIDs at the same time were slightly higher than those in patients taking NSAIDs alone, but with no significant differences (all P>0.05). Conclusion Patients who used tramadol preoperatively have a higher risk of reusing tramadol within 1 month of surgery compared with non-users. Patients receiving more intraoperative procedures during knee arthroscopy may rely more on tramadol for postoperative analgesia, but long-term use of tramadol may lead to adverse drug reactions such as gastrointestinal distress.